Was reading an email last night on the AIlist serve (Appreciative Inquiry). What struck me was two questions: "Could we even say that what we perceive as "problems" contain assets we haven't identified yet"? and "Does classifying something as a 'problem' mean that it can't be part of the solution"? Also, the comment that sometimes we need to bump up our thinking to a higher level, referring to Einstein's comment, "You can't solve problems by using the same kind of thinking we used to create them."
Why not use this thinking, this appreciative inquiry approach, in terms of "defensive medicine". As I mentioned in an earlier post, we can shift the conversation, frame it in terms of "preventive medicine", subsuming "defensive medicine" in it, and making "defensive medicine" part of the solution. Also, we can look at the assets in "defensive medicine" to help us get to a solution.
Wednesday, June 3, 2009
Tuesday, June 2, 2009
Defensive Medicine
While listening in on the web to a physician stakeholder discussion on health care reform, sponsored b HHS and the WH, I was particularly interested in one physician's comment that the cost of "defensive medicine" in the U.S. on a yearly basis is $120B! I've seen another number, a much higher one. Robert Wachter, M.D. states, in his book, Understanding Patient Safety, that reducing damages against health care providers would save $250B yearly in the U.S. in "defensive medicine" costs. My understanding of "defensive medicine" is medical practices designed to avert malpractice suits, such as overutilization of unnecessary and/or expensive testing and procedures, as well as referrals to unneeded specialists, questionable surgeries, and/or actions taken to specifically avoid liability, rather than to benefit the patient. I don't know how these "defensive medicine" figures have been calculated.
I just finished reading Atul Gawande's The Cost Conundrum in the June 21, 09 issue of The New Yorker. Gawande writes about the overuse of medical services to maximize revenue for health care providers. I don't suggest that this is a widespread phenomenon. I would doubt it. I do wonder, however, how many dollars of "defensive medicine" are associated with maximizing revenue, rather than trying to avoid liability.
In any case, can we reframe the conversation, shift it to "preventive medicine", a central focus of the disclosure process after adverse medical events. Very briefly, for purposes of this post, the disclosure process presents the opportunity to bring into the open patient safety issues and work with injured patients to prevent injury to future patients. That is preventive. Can we focus on this, on preventive medicine? If we do, the culture of "defensive medicine", the need for "defensive medicine", will be lessened and become less important.
I just finished reading Atul Gawande's The Cost Conundrum in the June 21, 09 issue of The New Yorker. Gawande writes about the overuse of medical services to maximize revenue for health care providers. I don't suggest that this is a widespread phenomenon. I would doubt it. I do wonder, however, how many dollars of "defensive medicine" are associated with maximizing revenue, rather than trying to avoid liability.
In any case, can we reframe the conversation, shift it to "preventive medicine", a central focus of the disclosure process after adverse medical events. Very briefly, for purposes of this post, the disclosure process presents the opportunity to bring into the open patient safety issues and work with injured patients to prevent injury to future patients. That is preventive. Can we focus on this, on preventive medicine? If we do, the culture of "defensive medicine", the need for "defensive medicine", will be lessened and become less important.
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